12 brain lesions—but it wasn't cancer: A neurosurgeon’s unforgettable case
Key Takeaways
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"In very rare cases, about 1–2% of the time, [this infection] can spread to the brain. And when it does, it usually causes a meningitis. Causing all of these tumors is extremely rare." — Rupa Juthani, MD, board-certified neurosurgeon
Neurosurgeon Rupa Juthani, MD, has seen her share of complex cases over the past 15 years—but nothing quite like this.
Her patient, a 49-year-old man, presented with a fairly routine complaint: dizziness and headache. A brain scan revealed a constellation of enhancing lesions—12 in total.
“It looked like textbook metastatic disease,” Dr. Juthani recalled in an Instagram Reel. “Multiple lesions lighting up with contrast like that? We were all thinking cancer.”
The diagnosis no one expected
The truth was far stranger. After surgically removing the largest lesion, pathology delivered a curveball: It wasn’t cancer at all. It was tuberculosis—a diagnosis that stunned even this seasoned neurosurgeon.
“TB can spread to the brain, yes—but this wasn’t the typical TB meningitis we sometimes see,” she said. “This was twelve tuberculomas masquerading as brain mets. Extremely rare.”
Brain TB: Rare, but real
CNS tuberculosis occurs in only 1–2% of TB infections, and even fewer cases present like this. Most patients exhibit signs of meningitis or abscess—not a dozen contrast-enhancing masses resembling cancer.
It's the kind of presentation that could easily prompt a full oncologic workup—and possibly unnecessary treatment.
Instead, this patient’s course changed dramatically. “We went from preparing for chemotherapy and radiation to planning a course of oral antibiotics,” Dr. Juthani said. “He’s expected to make a full recovery.”
A humbling reminder for physicians
For physicians, the takeaway is a reminder to keep rare diagnoses on the differential—even when the imaging screams malignancy.
As Dr. Juthani put it: “This is one of those cases that humbles you. It’s why we always send it to pathology. Because sometimes, the brain has other plans.”
Related: What if your hospital gave you a brain tumor?